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Now that’s what I call a surgeon general

It appears that Obama and his administration, while educating themselves admirably on health care issues as they’ve been doing for the past several months, have also clued in to the fact that there are doctors who aren’t on TV. Even before the inauguration, there were reports that Obama had asked Sanjay Gupta, a fatphobic blowhard of a TV doctor, to be his surgeon general (as Kate said at the time, “what, the Australian dude from ‘House’ wasn’t available?”). Six months later, Gupta having taken himself out of the running, they have suddenly hit what looks to me like a hole in one.

Meet Regina Benjamin. She runs a rural family health clinic serving the poor and underserved. It’s been destroyed twice by hurricanes George and Katrina, and she’s rebuilt it from the ground up. She believes in education and public health care. She’s won a MacArthur and several humanitarian awards. Bonus: she’s kind of fat.

Now, it’s not like having a fat surgeon general automatically means that she’ll be sensitive to fat issues. Some of the ugliest attacks we hear come from fellow fatties who find it terrifying when we tell them they don’t have to suffer. And Dr. Benjamin’s father died of diabetes-related complications, though I don’t know what type, so she probably feels very strongly about at least some of the diseases that are associated with fat — if she thinks they’re also unequivocally caused by fat, she may go ahead with the calls for public anti-obesity measures. They just won’t be as offensive to me as Gupta’s would have been because she seems like a real nice lady.

But this does mean that there’s a chance, however small, that Dr. Benjamin understands that fat is not automatically inimical to health. And her position as a doctor in a poor rural area probably means that she is more sensitive to the effects of poverty on health and food access, and might understand that lack of access to good nutrition or unbiased health care or leisure for activity — not fat bodies themselves — are problems to be solved. That’s a chance I didn’t expect us to get.

The surgeon general is often mocked as being a symbolic role, but it is possible to effect some change in the position, even if many people don’t — especially now, when the health system is potentially in overhaul. What would you want Dr. Benjamin to be aware of? What kinds of changes would you want her to instigate?

(P.S. go here for a much thinkier and generally better analysis of reactions to Benjamin’s body type.)

I suppose that she is probably the best choice among a collection of poor options (in the sense that probably anyone chosen would still be an allopath, and thus not really ‘progressive’). I’m not clear on the point of having a ‘chief’ governmental medical person anyways — doesn’t this just contribute to the continued institutionalization of a single system of medical theory/practice? And isn’t it time the U.S. struck a blow against the biopolitical management of bodies and ended the surgeon-general position altogether?

Yay for the humanitarian, trailblazer, and genius aspects! (Although I’m not sure why I should be proud of Obama for nominating a trail-blazing humanitarian genius for the role, because who else should be pick? But still.) She seems like she’ll be another inspirational woman in the administration, and the kinda-fat thing is a nice bonus.

Vidya, I disagree that only naturopaths can be progressive! I’m rather a fan of the scientific method, actually. (And before you jump on me, I’m not saying I love the medical establishment or big pharma or the way the government handles public health. But those things aren’t actually the same as allopathy.)

I think the government plays an important role in regulating industries and services for safety and ethics. That doesn’t actually have to be equivalent with body policing.

Wonderful news! I was just reading an article in the Times regarding the plight of rural health care. Since my peeps are from rural areas I’m excited to hear they’ve got an advocate in that office.

Mucho word Volcanista! I too like the scientific method.
I have a love hate relationship with Big Pharma. On one hand, I hate the prices and think they’re greedy pricks. I particularly loath the fact I have to get my medication from foreign countries just to vaguely afford it. I’d also like for them to do trials for psychotropics that are longer than 12 weeks. On the other hand, they make drugs that cured my long battle with the acne on my ass and a few that give me enough juice to think that checking out is unproductive at this time. Occasionally I’m actually glad to be alive.

Oh and Constance you’re so right about masturbation-Gate! Frankly I think Elders was a freaking genius!

I too thought of Dr. Elders and how so many in our country cannot handle real sexuality. Objectifying women to sell products is fine, but real sexuality is wrong. Maybe that is because real people are sexual and women in the media are on a pedestal of physical perfection.

But I digress. A report on NPR said she lost a sister (?) who smoked to lung cancer. Hopefully her approach to health will be more nuanced than weight blaming.

Vidya- while I understand where you’re coming from, please think about the effect your words may have on conditioned people. My best friend from childhood has a congenital heart defect and owes her life to allopathy. She’s had many sugeries and her illness has a huge effect on her life. She always finds it extremely hurtful when people express distaste for traditional medicine, as it extends to her body image. She is extensively scarred (which I think is beautiful, but she tends to cover them) and, in fact, only began to accept herself when she was introduced to the fat acceptance community (although she is quite slender). There is a time and a place for both allopathy and naturopathy.

Not to nitpick, but Vidya, for those of us in evidence-based medicine(1) the term allopath is highly pejorative and associates modern practice with pre-20th century practices like bloodletting, purging et cetera. It assumes that current, evidence-based practice has not moved on (which we certainly have.) I hope you didn’t mean it that way. And lots of us are progressive — fighting for universal health care, raising treatment standards and getting preventative and reproductive care at the fore, working for harm-reduction and quality mental, dental and visual health access… the list goes on.

The point of having a governmental medical official is to be the head of the Public Health Service Commissioned Corps, and serve as a spokesperson for that body and the Federal government on issues of public health. And actually, yes, we do need both the PHSCC and a spokesperson. We have epidemics, we have environmental emergencies that end up being public health emergencies (2) and behavioral concerns that are public health issues (3). (And hey, Koop screwed up on some stuff, but on some, he was great — getting basic, solid AIDS info into every household helped reduce the fear and prejudice and raise awareness when it was most needed. Same with Elders — we started having the national dialogue on safer sex policy. I don’t expect perfection out of anybody human.)

The PHSCC isn’t a big boat, but somebody’s got to steer it and the Secretary of Health & Human Services can’t do everything. Abolishing the PHSCC and the SG’s office won’t make the need for objective, public health information and action go away. We will still need (historical examples) labels on tobacco, funding for studies to prove that teaching 6th graders to use condoms prevents disease transmission and (if we’re really unlucky) an organization in place to flood the country with polio vaccinations or set up cholera containment.

Personally, I *heart* the scientific method so I really do want scientists, academics and physicians who use the scientific method (4) and peer-reviewed research to be in charge of public health policy and to to have a strong voice on public health issues. Amongst the hundreds of more important Public Health issues (IMHO, I think keeping infectious disease and environmental health issues under control is far more important), but to bring it back to body acceptance, science and evidence-based medicine are what’s telling us the relationships between diet and obesity are tenuous, while the relationship between early/extreme dieting and obesity is getting clearer. It’s not the above mentioned industries, who have a financial interest in Fear Teh Fatz!! (Unfortunately, the peer reviewed studies don’t get a lot of press because they don’t feed into Fear Teh Fatz that sells newspapers, ad space, diet books, or supplements. We’re still stuck with the media…)

(1) I’m an MS/Psych doing neurochemical research for my doctorate, so no, I didn’t go to medical school, but that was my choice, not because I didn’t get in; I did — I just couldn’t sign myself up for $150K of debt to have the privilege of dispensing drugs when I knew I wanted to go into research anyway.
(2) Hurricane Katrina, chemical spills, Mississippi flooding, etc.
(3)such as tobacco and alcohol warnings; Koop’s endorsement of early and frequent practical safer sex education — not abstinence only — and condom use to reduce the spread of AIDS; Elders’ willingness to fund research through the office into controversial topics like drug legalization and contraception education.
(4) as opposed to people like Atkins et al, “Dr. Phil”, the pontificating Sanjay Gupta, who is frequently about 5 years behind on his journal reading, Mercola, supplement industry, the diet publishing industry, the drug companies, the media, the spammers… )

I heard about her on the radio and thought, If she gets in, I’ll write to her office to ask that they look into the financing behind the studies for aggressive treatment of gestational diabetes and other medical management of pregnancy.

(I don’t disagree that medical treatment in pregnancy is good; but having been poked, prodded, and supervised to the Nth degree, costing my employers lots of money and making me miserable, didn’t actually do anything for either of our healths when I was pregnant; and it led directly to c-section due to ‘failed induction.’ And yes, I’m pretty sure a bunch of it was fatphobia. Certainly the aggressive treatment researcher is fatphobic.)

Constance, I disagree with you that “anybody has to be better than C. Everett Koop. Big fail.” Koop wasn’t perfect, by any means, but his push against smoking did an enormous amount of good. Looking back, it’s hard to believe … not just how many people smoked, but how acceptable it was to smoke anywhere, everywhere. Koop wasn’t using new medical evidence to say “stop smoking” and push back against the tobacco lobby. He just pushed really really HARD. Nowadays, it seems ordinary that public buildings don’t smell of smoke.

And Koop didn’t accomplish nearly enough, when the AIDS epidemic started. But he did one thing right. He pushed for more comprehensive sex education, based on biology. (Some of his risk estimates were mistaken, but in 1985 there wasn’t enough data for detailed risk assessment.) He advocated condom use. He advocated talking explicitly about previous partners, getting tested, and using condoms.

25 years later, it’s all too easy for me to imagine a Surgeon General who would roll over and play dead for the tobacco companies. (Or the makers of whatever drug or pollutant we’re casual about now, like people used to be so casual about tobacco.) It’s all too easy for me to imagine a Surgeon General who would cave in to political pressure and not want to talk about anything as embarrassing as sex.

Not to nitpick, but Vidya, for those of us in evidence-based medicine(1) the term allopath is highly pejorative and associates modern practice with pre-20th century practices like bloodletting, purging et cetera. It assumes that current, evidence-based practice has not moved on (which we certainly have.)

really? Allo- means “other,” right? I never knew the reason for that. thanks for sharing that!

Though bloodletting is still used for one or two things, of course. My grandmother had to have it done! crazy!

CZanna, thanks for the great discussion on the PHSCC. Public health programs are, I think, one of the few truly revolutionary social developments of recent human history and have produced incredible gains for both life expectancy and quality of life.

Not to detract from that, and because I just like pondering the curious ways our world works, I can’t resist pointing out that public health efforts and war are often inextricably linked. (Of course, the PHSCC is a uniformed service.) The pattern usually was that forward-thinking folks had been voices in the wilderness, pushing new ideas for a while, until a conflict provided the opportunity to demonstrate their value. Nursing as a vocation, with the understanding that not all women in the vicinity of armies are prostitutes or washerwomen–mid-nineteenth-century wars like the Crimean, American Civil, and Franco-Prussian Wars. Nursing as a profession, requiring training and competence–World War II. World War I was especially productive, both because the military was horrified at the number of men disqualified for health reasons, and because it produced the country’s first government-sanctioned STI awareness campaign.

Also, a lofty goal like “protecting the country’s health” does have the potential to produce some misguided results. An interesting read in this area is “Typhoid Mary: Captive to the Public’s Health” by Judith Walzer Leavitt.

Though bloodletting is still used for one or two things, of course. My grandmother had to have it done! crazy!

Don’t they do it for haemochromatosis?* (You can do it yourself through the medium of giving blood.)

*The medical condition which Sandra Oh tragically mispronounces in Season 1 or 2 of Grey’s Anatomy, thus destroying a) my suspension of disbelief that they are real doctors and b) my confidence in the editors/medical consultants/fact-checkers employed by GA. How poor.

I started a comment, and it turned into a blog post, here.
I’m so glad I read about this here and not when I got to work, at which point I would have had to wait the whole day to get back to my home computer to be able to say anything about it!
Insomnia (I’m on the West Coast): Good for something after all!

I’ve *met* Regina Benjamin! She was the keynote speaker for the Women of Color event two years ago in Omaha, NE. I was on the committee for that event, and she is marvelous to work with.

Her speech at the event was so inspiring – she talked about how poverty does not equal lazy, and how her patients did not want charity but wanted to pay their bills, how one patient had terrible back pain but went to work anyway *stripping floors* because she felt responsible for getting the work done. We even had the Omaha World Herald come and do an article on Dr. Benjamin and the event (trust me, this is something with the World Herald).

I admit I’ve had some reservations about many of Obama’s nominations for various positions, but this one I am 100% behind!

As another person on this site involved both personally and professionally in the medical practice and science I have to thank CZanna and volcanista and others for standing up for the scientific method. It is only through Western medicine that my husband and I are still walking the earth and I work EVERY DAY to make sure that patients and research subjects are treated with respect and justice. Also, C. Everett Koop went against Reagan and his administration to do what he thought needed to be done in HIV prevention; which is a whole lot more than anyone else was doing outside of the HIV activist community.

@CZanna. I did not know that allopath could be used pejoratively. I thought it described the majority of doctors who were not osteopaths.

I read an article by Dr. Weil explaining the benefits of both allopathic and alternative medicine and he did not use it as a slur at all. I guess this is one of those words where in at least some circles, the connotative meaning has been eclipsed by the denotative meaning.

I also wanted to point out that Dr Benjamin’s brother died of an AIDS related cause. I think/hope her perspective will help draw more attention to the issue of HIV-AIDS in the African American community.
or, even better, maybe she’ll help normalize HIV testing and prevention for the ENTIRE nation. That would be a mitzvah in and of itself.

Looks good, I’m also very happy that she’s a family doctor, they don’t get nearly enough respect. And with her perserverance I expect that she’ll be able to overcome the doubters, she faced down hurricanes after all.

CZanna – you wrote the comment I wished I could write. I would like to point out one small thing (sorry for being nit-picky, just have to stand up for my profession.) You wrote “I just couldn’t sign myself up for $150K of debt to have the privilege of dispensing drugs when I knew I wanted to go into research anyway.” Physicians diagnose disease, pharmacists have the privilege of dispensing drugs.

I am stoked about the nomination of Regina Benjamin. She’s been in the “trenches” of healthcare delivery and brings a real world perspective to D.C.

I was glad to hear/read about this nomination. I have great hopes for Dr. Benjamin.

What would I like to see her tackle? The addition of corn syrup to every darned thing. It needs to stop. Now. Also, I would very much like to see a revision of the food pyramid, as it is horribly outdated and (I would argue) dangerous to perpetrate on yet another generation. I would like to see BMI relegated to the trash heap, as it is an imprecise mathematical calculation based one an admittedly flawed premise, but that may be too much to ask.

What really tickles me, apart from all the amazing credentials and credit to an amazing human being of course…is how she kinda looks like Dr. Baily….seriously. I mean her face is wider and her nose and chin are both shaped a bit different and I think it might just be the haircut, but…seriously.

As soon as I saw Dr Benjamin’s picture, I thought “Oh boy! Let’s had over to Shapely Prose for the party!!”

Diabetes, i.e. what her father and my grandfather died of, is indeed a serious disease. But although it is weight related (in the sense that as far as I understand if your body makes little insulin, it might be still enough at a certain weight but become not enough at a higher weight) fat doesn’t cause diabetes, nor does diabetes necessarily make you fat.

My grandfather was diabetic from age 25 to his death at 80 and he never was fat. He did however have very bad wounds in his kegs which took longer and longer to heal and hurt like hell.

May I add, if you’ll excuse the shallow comment, that Dr Benjamin shows that you can be fat and at the same time intelligent, healthy, and good looking?

On a different note, did you all hear that the UK has distributed a pamphlet to teenager pupils claiming that sex is pleasurable and that masturbating once a day is healthy? I find that so totally awesome.

r.e. the Elder controversy… as JennyRose said above, “Objectifying women to sell products is fine, but real sexuality is wrong. ”

I always find it amazing that in the US we have this culture that can be so crass and oversexed, yet simultaneously prudish. Once you get on the topic of sex that happens between actual people, it’s off limits. Admitting that sex can occur with just one person, or more than two people, or among people who are fat, or the same gender, or transgendered, or different colors, or disabled, or old, or in any way not conventionally gorgeous… that’s right about when we start to get all prissy.

I’m so excited about this! If I were to ask her to do one thing for me besides be fat positive, and I’m not even sure it’s in her power, it would be to force insurance companies to pay for birth control pills for women or the equivalent for men (if they exist now or ever). I hope she will be able to use her position to also impact the AIDS crisis here and abroad.

What would I like to see her tackle? The addition of corn syrup to every darned thing. It needs to stop. Now.

Well, good luck with that. That’s really under Agriculture, which means taking on the farm lobby and the subsidies that make for a whole lot of cheap corn that needs to be dumped somewhere. And it goes into HFCS as well as into animal feed. And a lot of those animals — like cattle, for instance — aren’t designed to eat corn, so they get ill a lot, which leads to them being given antibiotics as a matter of course to prevent illness. Ain’t food production fun?

Koop dragged his feet, but when he did finally speak out about AIDS and recommend the use of condoms, it carried a huge amount of weight. Here was this old conservative Christian doctor telling people to have sex with condoms (which you couldn’t even get without asking the pharmacist back then) and treating AIDS as a medical problem rather than a moral one. It was a very big deal.

So far I’m liking her, we’ll see how she handles the D.C. pressure. Unfortunately, politics and medicine don’t usually see eye to eye.
Chava, LOVE your question to your MD spouse, and his response. This is definitely a question we should be asking the medical community more, since they are making sweeping comments, I would like to see the actual real proof that A causes B, and exactly how. Too many times has the medical community said something was bad (or not) for us, and low and behold, and then years down the line completely reverse their opinion. Working with your body, not against it to force it to become something it isn’t, is a much better solution.

Chava – that is an excellent question! Did your husband come up with an answer?

If what estraven says above is right, that might go some way to answering the question, but it still is exactly the kind of question that isn’t getting asked right now outside of places like SP and really should be:

But although it is weight related (in the sense that as far as I understand if your body makes little insulin, it might be still enough at a certain weight but become not enough at a higher weight) fat doesn’t cause diabetes, nor does diabetes necessarily make you fat.

chava, there have got to be some great takedown articles about fat => diabetes on JFS, though I can’t go hunting for them right now (and searching the site isn’t easy).

As for the corn syrup… yeah, I agree with zuzu. Since the only real problem with corn syrup being used a lot is that it perpetuates some agricultural practices that are arguably bad (environmentally and in terms of sustainability), that’s a battle over farm subsidies and with a different part of government. Corn syrup = sugar and doesn’t really have very much to do with population health.

Sun, I’m not sure it’s “too many times,” at least. The way trial studies are blown out of proportion is a biiiiiig problem. But science is all about coming up with models and testing them, and then refining and refuting/replacing them. It’s how the method works. I think it’s the interplay between medical science and popular news and funding agencies and practicing doctors is the issue there. I would love to see something done about THAT, but I’m not sure how.

well because you eat so much, and that makes your body make too much insulin

And it’s not remotely possible that different people have different cutoffs for how much food is needed before insulin production becomes dysfunctional! I mean, that would imply that there exists some kind of genetic predisposition to diabetes, and we all know that’s not true!

well because you eat so much, and that makes your body make too much insulin

Chava, I’m glad your husband saw the flaw in his reasoning once you pointed it out, but it terrifies me that doctors think like this. I’ve seen at least fifteen GPs and thirty specialists for various things and only two of all those doctors have been non-fatphobic (one because he specialises in a disease which makes weight gain inevitable and weight-loss impossible). I mean, your husband’s statement about eating so much etc is so simplistic and blatantly unscientific and yet that’s what doctors are being taught, and what they believe, and oh my god, the implications for insulin-resistant people all over the place are really scary. It must have been a relief to you when he realised you had a point.

He’s still in training, so it is even more directly what they are teaching them, which is deeply troubling. He’s getting a PhD in heath economics, though, and seems pretty certain that weight and diabetes ARE correlated, but it’s the medical *why* of it that seems to result in a “bzuh??”

That reminds me, I need to annoy him into looking at the possibility that it is the poor medical care “obese” people receive that might be skewing the numbers rather than their obesity itself.

“seems pretty certain?” do you think that if you show him how weak those correlations actually are he’ll buy it? Oh and Puhl and Heuer (2009) is a good (and loooooong) review article about stigma in treatment.

I did say “correlation,” not causation–as far as I know, studies show BMI and Type II as linked but WHY they are linked (stigma in treatment, possible genetic predisposition, bias in diagnosis, the huge problems with BMI in the first place) is where doctors are falling down.

I’ll point him towards the Puhl and Heuer. We’re going one thing at a time here, last week it was airline seats, this week it’s diabetes.

Anyway, it came to mind because in Dr. Benjamin’s acceptance speech she mentions diabetes a few times.

I’m a type 1 diabetic so I don’t know that much about type 2, but what I do know doesn’t support the idea that “eating too much” causes type 2 at all. It’s true that insulin efficiency increases with exercise (ie, you need less of it to convert the same amount of sugar to energy), so an athlete’s body is probably very efficient with its insulin. The way type 2 works is that the body makes insulin, but the cells can’t use it adequately. When this happens, the pancreas realizes that the blood sugar is rising, and so it floods the body with insulin in an effort to get the blood sugar back to normal. This is the step that some people suspect actually CAUSES weight gain, supporting the theory that type 2 comes first and fat comes later. Exercise allows the cells to regain their efficient use of the insulin the body makes. As far as I know, weight loss by itself will only increase insulin sensitivity a little. I think it’s just that weight loss and exercise have become so intertwined in people’s minds that they can’t imagine one without the other. And apparently doctors prescribe weight loss as treatment when they actually mean to prescribe (or should be prescribing) exercise, which is the most efficient way to increase insulin sensitivity.

I’m hopeful about this nomination. We need an advocate not just for healthful living, but for healthful living without affordable food, health care, electricity, etc. People can (and do) proselytize all day about perfect diets and exercise regimes, but it means nothing when you can’t afford basic essentials.

Also interesting is how some have freaked out over the *bodies* of some of Obama’s potential and actual female political and judicial nominees. Some objected to Elena Kagan’s possible nomination to the Supreme Court because of her weight and Sotomayor’s nomination because of her weight and diabetes. Seizure-prone Chief Justice Roberts didn’t go through anything like this. Now we have Regina Benjamin who has the nerve not to look like Surgeon General Barbie.

Volcanista, I worked in the medical profession for some years, and the things I heard come out of doc’s mouths based on one or two extremely limited studies would curl your hair. Those of you in the field know what I’m talking about. Just off the top of my head, there’s phenfen, which almost killed my sister. (Who is STILL on a quest of possible self mutilation because she’s so unhappy, and thinks that being thin will make her so), and let’s not forget the doc last November who gave my 84 year old mother Plavix, KNOWING she had a stomach tumor which was only being kept from bleeding out was the meds from her oncologist. She died a week later in my sister’s arms, bled to death.

I’m an anthopologist, so I’m very well versed in scientific method, that’s how we do our work. But a new treatment or drug shouldn’t be rushed out as safe, when it’s not. My brother also died from stupidity, unfortunately his own, when he let a doc talk him into an ‘alternative’ and totally untested treatment for his lymphoma. The treatment caused his death, and if he had taken the standard treatment for lymphoma, he’d been cured and still be alive today. Bottom line here, M.D.’s are still ppl, they make mistakes, and it is in your own best interest to educate yourself ( which is what we here are doing, to combat the obesity myth.)

Let’s hope our new SG is good to go, and hopefully she won’t get brainwashed by the politicians. ;)

Pinky, you are so right about affordability of healthy food. I have been working on a study of urban agriculture, where ppl in depressed areas w/o access to fresh food are growing it themselves. Google ‘urban agriculture’, you’ll find some very interesting reads. I would like to see the SG looking into this, it is a cheap and fairly easy remedy for good fresh food for inner city lower income areas.

I would love, though this is probably WAY too much to ask, for her to make eating disorders and eating disorder prevention an important issue. I’ve had to go through hell trying to get help, because there is such a lack of awareness by everybody, including most doctors.

I’m listening to The Ron Reagan Show right now, and he just got through talking about the new Fat Hysteria Topic: “Our New Surgeon General is… *gasp* a FAT WOMAN!!!!”

Here are a couple comments of his choice comments, made to some children’s health advocate he is interviewing on the subject:
“Now that she’s Surgeon General, she’s more or less ~obligated~ to lose weight! *chortle chuckle*”… or “It’s a great opportunity for her! [to ~finally~ lose some weight]!!”

or, while the interviewee was describing a community program at her schools to where local farmers bring in fresh produce for the kids: “What do you think about ~her~ being, maybe, someone who ~hasn’t~ had enough fresh fruits and vegetables in her life?”

Ordinarily I like Ron Reagan, although the two nights he interviewed Marianne he was a bit smarmy… but OMG tonight??? I haven’t heard him EVER be this ~patronizing~, this ~condescending~, this… NASTY (and all in his cheerful peppy voice)…. ever.

I was watching a bit of MSNBC while waiting for my lunch and the “Dr. Nancy” show was coming on. One of today’s topics “Obama’s new Surgeon General pick is underfire on the internet about her weight.”

I don’t watch TV really (not by choice, just don’t have cable and haven’t been able to get the new digital box to work with TiVo – because once you’ve have a TiVo, you can’t just go back), so admittedly I’m not up on the latest TV news show trends, but is covering Internet gossip about a woman’s body considered news now?

I’m cautiously optimistic, especially given Rachel’s comments. I hope that the influence of oppression on health can get some focus as well. Other fat people are some of the worst haters though.

And can I just say that I wore my “Fat is a Phenotype, Not a Disease” tee shirt to my doctor’s office this morning and was met with cheers from staff, and shown off to everyone? I LOVE my doctor and his staff!

But…

Doctors receive absolutely no science education in med school, hence their sometimes astonishingly stupid beliefs about health. Med students are made to dissect and identify and memorize things, but there is no training in the scientific method, statistics, research design or the difference in importance between lab values and health outcomes. Statins (which lower cholesterol values but INCREASE death rates) would be prescribed about one thousandth as often if doctors understood the research on them.

Certainly there are doctors who are also scientifically literate, but it’s usually sheer coincidence when it happens. *sigh*

While I’m at it, as a person who occasionally depends on doctors to save my life, I would prefer that they were required to demonstrate prior to med school admission:

1. An aptitude for UNDERSTANDING medical and scientific research. I really couldn’t care less if they are brilliant scientists themselves. I sure as shit don’t care if they’re good at physics. I want them to know that epidemiology can never establish causation. Correlation does not establish causation. Period. Ever.

I want them to know they need to read their journals weekly, and that they can’t rely on the authors’ conclusions but need to read the WHOLE paper and draw their own conclusions. The ability to understand basic genetics and MZ vs. DZ twin vs. parental concordance is needed. Knowledge of the relative scientific strengths and weaknesses of quantitative and qualitative research should be firmly in place as well. With rare or currently untreatable illnesses, and even healthy conditions like pregnancy where you can’t just randomly assign treatment and no-treatment groups, following a population clinically is both ethical and informative.

2. An ability to LISTEN to what patients say and what they don’t say, and draw correct conclusions then check with the patient (and witnesses) to clarify. This can be done in seconds in an emergency. A couple of social work courses in assessment would instill this critical ability.

3. A basic understanding of human psychology, including but not limited to: human developmental stages; motivated behaviors (thirst, sleep, hunger, breathing, pain, pleasure) that are not under a person’s control; a class on the biological basis of addiction (neurologically similar to epilepsy) as opposed to psychological dependence (which happens equally with marijuana, hugs, and asthma inhalers), and last but not least the common mental illnesses.

5. While we’re at it, how about a grounding in health (including pregnancy) on which to build a separate and parallel knowledge of pathology. I want doctors to recognize the natural variation in human phenotypes, and the effects that harsh or oppressive environments have on individuals and groups over time.

6. Economics, including a thorough review of the cost of treatment and medication compared to the typical income levels of different populations, so that they will not label poor people “non-compliant”.

7. Ethics – so that when they see other doctors abusing or butchering patients, they REPORT them to the police. And so when they are having trouble themselves, they seek help instead of harming patients and relying on other doctors to cover for them.

8. A medical history class detailing health and science fads that are still with us today. Positive fads are important, but aversion fads are critical to understanding that one’s own biases can cloud clinical and scientific reasoning.

I’d rather be treated by an English Literature BA or Auto Mechanics AD with those skills than a double major Biochem/Physics undergrad without them. It amounts to ten undergraduate classes at the most, only two semesters even for relative slackers.

And while we’re at it, I want working interns, residents and attendings to get at least 8 hours of sleep in 24. I’ve nearly been killed by doctors who were so sleepy they couldn’t have counted to ten if asked. Fortunately, either nurses took over and TOLD the comatose docs what to do, or I was an asshole and demanded a doctor who was competent to make legal decisions, let alone diagnoses and treatment decisions. How can people emerge from even a basic biology class without understanding that humans need sleep?